Meter Swap Request Number: 15325
Pubfic Works Division
Service Request
Problem Address: 150 H�Circle Requested By: Jeff Niblack
Departmeat: WA'IER Addrase: No address Rovided
ProWemlIsBue: INSTALI.AMR METER Phoae Number: 612-280-7863
Scheduied Datte: 2017-OS-16 Sei�edolea Tlme: 08:UQ:00
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ACTION NEEDED:
Cres�tei by: Beth Koadrick Date Cre�;ed: 2017-OS-12
AC'IiON T'AI�N:
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5tatus: In Progress gebmitter Hss Been �.
Co�ted
Date Completed: Completed by:
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- City of Fridley /�� 2 )
Water Department � J
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6431 University Avenue NE � �
Fridley, MN 55432 �
763-57Z-3566
�/we hereby authorize the City of Fridley and/or its employees to do what is necessary to
replace the water meter. 1 understand that the property owner is liable for the water line from the main to the premise and all interior
plumbing. (Per City code 402.06) 1 afso hold the City of Fridley andjits employees harmless for any damages tbat may occu�while doing this
operation. This to incfude,but not limited to valves,piping,walls,floors or the curb stop box and service line. In understand f am aiso required
to obtain a permit prior to any work,if necessary.
FINAL METER READING(old meter)
Name• Address �S� 1'Tr��Ati'Q�t�. t.l,�.
Phone Number Date
Signature Witness 5ignature
OLD METER# �3� 3G 2 � Z.
OLD READING I � � f � L( D l� �
NEW METER# "
NEW READING "'" 33�3 �Pa`a'a'�
ERT# �� O <� �7D �
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FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
ADMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,98$,1144,1156,1191)
402.5 PERMlT FEE
Prior to constructing or repair of any water of sewer line connecting the existing munitipal systero and any house or building for which the
application is made,the owner or contractor shall be required to obtain a permit for such connection,and shall pay a permit fee as provided in
Chapter 11 of this Code. After such connection has been made,the Water and Sewer DepartmeM shall be not�ed. It shall be unlawful to cover
any connecting line until an inspection has been made and such co�nection and the work incident thereto has been approved by the City as a
proper and suitable connection.
402.06 REP141R5 AND MAINTENANCE TO CONNECTION
After the initial connection has been made to the water senrice curb stop box or the sewer fead at the property line or a water unrice lead has
been extended to the property line far connection,the applicant,owner,or occupant or user of such premises shall be Itabie for all repairs
required to any water fine and sewer lines necessary for connection of the premises from the main to the premises. If the property ovrner
requests maintenance service or repairs be performed by the City,the property owner shall be charged for the costs of the mairrtenance and/or
repairs,including necessary street repairs at a rate set annual{y by an administrative poiicy. It shall be the responsibility of the applicant,
owner,occupant or user to perform standard maiMenance of the sewer service line from the premises to the main including debris clearing or
root cutting and to maintain the water service curb stop box for operability and at such height as wiN ensure that it remains above the finished
grade of the land or property. (Ref 638,1156,1191)
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city of Fridley
Water Department
Address � � �QZ"�� �R,
Name t2��
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L�ate �--��� �.-.� -� ;(� � �-
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Old Meter Number �,w�•
Old Meter Reading �� �"�
Repl acement No. �� C,l� ,��---�—
Replacement Reading� `
Replacement Make ��_ ;�_
Remarks• ���l,�i���
S igned���� �°"��
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